That quote is from the great philosopher and clinician, oh wait I mean 80’s post-punk rocker Adam Ant. Seriously. But he is so right on.
Back in 1998 I was part of the management team of a company called Merit Behavioral Care, also once known as American Biodyne. The company was the first of its kind: a company that delivered what we now know as population health for people with mental health and substance abuse challenges (then called managed behavioral healthcare). We looked essentially like an insurance company or HMO specifically for people who need that kind of help. We had a huge network of psychiatrists, psychologists, social workers and the like, did care coordination and utilization review, paid claims and did everything associated with accessing, using and paying for behavioral healthcare services.
I had joined this company’s management team in 1989 when it was an early stage start-up and, by the time I exited stage left 9 years later upon it’s ultimate sale to Magellan Health, it had grown to serve more than 35 million beneficiaries. When I left the company to work in the venture world, I assumed that I would see every behavioral health deal that anyone thought of, given how steeped I had been in that marketplace for so long.
To my surprise, I saw almost nothing of the kind; there was a remarkable dearth of innovation in that sector for much of the next 15 years. Given how much was (and remains) left to do to improve access to and quality of behavioral healthcare for those in need (and that’s a lot of people since it is estimated that about 20% of us have some sort of mental health challenge worthy of attention in our lives), I was amazed at the deafening silence from entrepreneurs in this sector.
And yet, suddenly out of nowhere, or not really, but after a noticeably long pause, mental health innovation is back, baby. Over the last couple of years I have started to see not just one or two, but probably 20 companies that have the improvement of mental health and substance abuse treatment as their primary focus. And hallelujah for that.
Clearly this is not coincidence and since it’s healthcare, follow the money (or the regulation that delivers the money). The massive uptick in interest and innovation around mental health stems from two things, at least in my opinion. The first is the largest expansion of mental health coverage in decades that was built into the Accountable Care Act. With its passage came rules requiring that most individual and small employer health insurance plans, including all plans offered through the exchanges, cover mental health and substance use disorder services on parity with medical services. This also includes preventive services, such as depression screening and pediatric assessments of behavioral health, which are largely covered for no cost to the patient. This is a big change from what came before, where mental health and substance abuse coverage paled in comparison to what was covered for medical services and, thus, helped keep innovation at bay by limiting reimbursement.
A second factor in the growth of behavioral health innovation is the recently opened dialog about the important role that behavioral change plays in all forms of healthcare and wellness. Whereas this whole topic was rarely talked about in the past outside the academic (and Merit Behavioral Care) discourse on “medical offset effect,” the rise of wellness and prevention services and the focus on patient engagement in managing their own chronic medical conditions has created an open discussion about how people’s state of mind (including mental health status) affects their own overall health status and willingness to improve it. The more this becomes part of the regular conversation, the more we chip away at the damaging stigma that has kept far too many people from their best health status.
And it doesn’t hurt that celebrities far and wide have made it a virtual badge of honor to talk about their mental health and substance abuse challenges on the cover of People Magazine and in the 140 word missives of Twitter. While sometimes gratuitous or weirdly sad, seeing your famous heroes survive the breakdown and subsequent treatment to rise again to box office fame can help take the embarrassment out of the process of seeking help or at least telling your friends and family that you need it. It makes me wonder how Amanda Bynes and Charlie Sheen are doing right about now. Hopefully they are #winning!
I am impressed by the commitment to behavioral health innovation I have recently seen among digital health entrepreneurs. There are some really meaningful companies out there making a powerful difference in people’s lives. Among my personal favorites are Big White Wall, which harnesses the power of peer-to-peer interaction supported by professional guidance; Abilto, which uses counseling techniques to improve outcomes for those who have experienced serious medical conditions (e.g., heart surgery) to keep depression and other behavioral health challenges from impeding their recovery; Freespira, which uses a unique medical/digital device to treat panic disorder; and Ceresti Health, which is building cognitive behavioral health solutions for those with Alzheimer’s and other dementias.
There are an amazing array of others, such as Breakthrough, recently acquired by MD Live, which was the first to build a dedicated telemedicine network for access to behavioral health professionals and Lantern, which helps people access simple and clinically-valid behavioral interventions through the web on a self-serve basis. Ginger.io, and Empower Interactive are out there serving patients, and there are a host of others.
And since mental health is a condition that has relevance and importance worldwide, we are also seeing innovation from all corners of the globe. I was recently introduced to a Spanish company called Psious which uses virtually reality glasses to help people access de-sensitization therapies to cope with their phobias, such as fear of flying, and fear of needles, and which may have a role in treating PTSD. If these guys can come up with an app to treat fear of venture capitalists they will really hit the jackpot.
This is hardly an exhaustive list; there are probably a dozen other companies I could name off the top of my head and many that I surely don’t know that also deserve recognition. There are so many interesting new entrants that the California Health Care Foundation is soon dedicating an entire day showcase and discussion to behavioral health innovation, and I’m sure they couldn’t accommodate all of the companies to speak who would otherwise belong in such a session. Had they held such a session 10 years ago, you would have heard crickets, not entrepreneurs. And these companies are getting funded by venture capitalists who know a big market opportunity when they see one. It’s good to see Adam Ant getting his wish.